A case is presented describing an association between obsessive–compulsive disorder, tattooing and unusual sexual practices.

A single case report.

Tattooing and unusual sexual practices are compulsive behaviours associated with the subject's obsessive–compulsive disorder. Such associations have not previously been described in the literature.

To evaluate the characteristics of Chronic Fatigue Syndrome (CFS) in primary and tertiary care.

A comparison of subjects fulfilling criteria for CFS seen in primary care and in a hospital unit specialising in CFS. Subjects were 33 adults fulfilling criteria for CFS, identified as part of a prospective cohort study in primary care, compared to 79 adults fulfilling the same criteria referred for treatment to a specialist CFS clinic.

Hospital cases were more likely to belong to upper socio-economic groups, and to have physical illness attributions. They had higher levels of fatigue and more somatic symptoms, and were more impaired functionally, but had less overt psychological morbidity. Women were over-represented in both primary care and hospital groups. Nearly half of those referred to a specialist clinic did not fulfil operational criteria for CFS.

The high rates of psychiatric morbidity and female excess that characterise CFS in specialist settings are not due to selection bias. On the other hand higher social class and physical illness attributions may be the result of selection bias and not intrinsic to CFS.